Xanthogranulomatous Inflammation of the Aortic Aneurysm Wall after Endovascular Aortic Repair for Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA)．Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.

Long-term Results of Surgical Treatment of Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A follow-up study of 98 patients undergoing abdominal aortic aneurysm (AAA) repair for 44 months, ranging 2 to 113 months, revealed no difference in 5-year actuarial survival between patients aged 75 or older and patients aged less than 75. The 5-year actuarial survival of ruptured and nonruptured AAA cases was 469% and 71.2%, respectively (<i>p</i><0.01). Late deaths after the repair of ruptured AAA were all due to atherosclerotic diseases. During a follow-up period after AAA repair, 9 patients were diagnosed as having malignant diseases with a fatal outcome in 6. Careful attention to atherosclerotic and malignant diseases is indispensable for follow-up management after AAA repair.

A Case of Aortic Stenosis Secondary to Bicuspid Aortic Valve Associated with Klippel-Feil Syndrome Treated by Aortic Valve Replacement / 日本心臓血管外科学会雑誌

A 52-year-old male was diagnosed as having aortic stenosis secondary to a bicuspid aortic valve associated with Klippel-Feil syndrome. Aortic valve replacement was successfully performed without any problems in the surgical or anesthesiological management. Only five such cases including ours, who underwent cardiac surgery have been reported. It is possible to perform cardiac surgery for patients with Klippel-Feil syndrome of their cardiac function can be well preserved.

Risk Factors in Arteriosclerosis Obliterans: A Comparison Study with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

In order to elucidate risk factors in arteriosclerosis obliterans (ASO), histories and physical and laboratory findings were reviewed in 163 patients with ASO, and the results were compared with ischemic heart disease (IHD) patients. Patients with ASO were much older and smoked more than patients with IHD. Such complications as hypertension, cerebrovascular disease were significantly more frequent in ASO patients than in IHD patients. On the other hand, the levels of serum total cholesterol, triglycerides, Apo A-II and Apo B were significantly lower in ASO patients than in IHD patients, although lipoprotein(a) tended to be higher in ASO. In ASO, remnant-like particles cholesterol tended to be higher when other presumable atherosclerotic risk factors were absent. The present results indicate that male gender, aging, smoking habit, hypertension and cerebrovascular disease are major risk factors in ASO patients. Although abnormal lipid metabolism may contribute to the development of ASO, we postulate that it plays a less significant role in IHD.